定痫汤加减联合左乙拉西坦治疗难治性癫痫患者的疗效观察

Clinical Efficacy of Modified Dingxian Decoction Combined with Levetiracetam in the Treatment of Refractory Epilepsy

目的观察定痫汤加减联合左乙拉西坦治疗难治性癫痫患者的临床疗效。方法选取2020年12月-2021年12月期间河南省南阳市第一人民医院神经内科收治的90例难治性癫痫(Refractory epilepsy,RE)患者作为研究对象,采用随机数字表法分为对照组和观察组,每组各45例。对照组采用丙戊酸钠及左乙拉西坦联合治疗,观察组在对照组基础上予以定痫汤加减口服,两组患者均持续治疗12周。观察比较两组患者临床疗效、不良反应情况,治疗前后认知功能评分、生活治疗评分、外周血神经递质[5-羟色胺(5-Hydroxytryptamine,5-HT)、多巴胺(Dopamine,DA)、脑源性神经营养因子(Brain-derived neurotrophic factor,BDNF)]水平、血清神经元特异性烯醇化酶(Neuron-specific enolase,NSE)及S-100β蛋白(S-100βprotein,S-100β)含量。结果治疗后两组患者MoCA量表各维度评分均较治疗前明显升高,差异有统计学意义(P<0.05);且观察组MoCA量表各维度评分明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者QOLIE-89评分均较治疗前明显升高,差异有统计学意义(P<0.05);且观察组QOLIE-89评分明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者5-HT、DA水平均较治疗前明显升高,BDNF水平均较治疗前明显降低,差异有统计学意义(P<0.05);且观察组5-HT、DA水平明显高于对照组,BDNF水平明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者NSE、S-100β水平均较治疗前明显降低,差异有统计学意义(P<0.05);且观察组NSE、S-100β水平明显低于对照组,差异有统计学意义(P<0.05)。治疗后观察组总有效率91.11%(41/45)明显高于对照组77.78%(35/45),差异有统计学意义(P<0.05)。治疗期间,观察组不良反应总发生率11.11%(5/45)与对照组13.33%(6/45)比较,差异无统计学意义(P>0.05)。结论定痫汤加减联合左乙拉西坦能够有效改善RE患者认知功能,提高生活质量,提高临床疗效,具有较高安全性,其作用机制可能与调节RE患者神经递质水平,减轻神经损伤有关。

Objective To observe the clinical efficacy of modified Dingxian Decoction combined with levetiracetam in the treatment of patients with refractory epilepsy(RE).Methods Ninety patients with RE treated at the Department of Neurology of Nanyang First People′s Hospital,Henan Province,from December 2020 to December 2021,were enrolled and randomly divided into a control group and an observation group according to a random number table,with 45 patients in each group.The control group was treated with sodium valproate and levetiracetam,while the observation group received oral modified Dingxian Decoction in addition to the control group′s treatment.Both groups continued treatment for 12 weeks.The clinical efficacy,adverse reactions,cognitive function scores,quality of life scores,levels of peripheral blood neurotransmitters[5-hydroxytryptamine(5-HT),dopamine(DA),and brain-derived neurotrophic factor(BDNF)],and serum levels of neuron-specific enolase(NSE)and S-100βprotein(S-100β)before and after treatment in the two groups were compared.Results After treatment,the Montreal Cognitive Assessment(MoCA)scale scores in various dimensions were significantly higher in both groups than those before treatment(P<0.05),and the scores in the observation group were significantly higher than those in the control group(P<0.05).The Quality of Life in Epilepsy Inventory-89(QOLIE-89)scores were significantly higher in both groups post-treatment than those before treatment(P<0.05),with the observation group showing significantly higher scores than the control group(P<0.05).Post-treatment levels of 5-HT and DA were significantly elevated,while BDNF levels were significantly reduced in both groups compared to pre-treatment levels(P<0.05).The observation group had significantly higher 5-HT and DA levels and significantly lower BDNF levels than the control group(P<0.05).NSE and S-100βlevels were significantly reduced post-treatment in both groups(P<0.05),with the observation group showing significantly lower levels than the control group(P<0.05).The overall effective rate was significantly higher in the observation group(91.11%,41/45)than the control group(77.78%,35/45)(P<0.05).During the treatment period,the total incidence of adverse reactions was not significantly different between the observation group(11.11%,5/45)and the control group(13.33%,6/45)(P>0.05).Conclusion Modified Dingxian Decoction combined with levetiracetam can effectively improve cognitive function and quality of life in RE patients,enhance clinical efficacy,and has high safety.Its mechanism of action may be related to regulating neurotransmitter levels and reducing neuronal damage in RE patients.